COVID19 keeps being a challenge, not only facing the outbreak and the treatment of the cases, but also in the education sector. Most learning centres and high schools in the world are closed to avoid further outbreaks, as well as institutes for psychotherapy throughout the world.

To gain a better knowledge and understanding about alternatives identified in the scope of psychiatric trainee training, through the support provided by digital resources.

Systematic review on PubMed and Uptodate databases since declaration of the COVID-19 pandemic in March 2020 was performed using the keywords: Distance Education, Pandemia, COVID-19, Medical Residency. Discussing online-learning.

The described European countries (Germany, Spain, United Kingdom) used different strategies to maintain the e-learning. Practical undergraduate education was replaced in countries like Spain by “problem-based learning” tasks, clarifying and commenting case reports or videos through working groups. The increase of the resources from teachers and trainers wasn´t taken in account for the preparation of the digital program. Social inequities for the digital access for groups of students or clients were also claimed.

Each of the described countries adopted different strategies regarding continuing training of residents, their assessment and their certification. Covid-19 should set down a trend of social collaborative learning as part of resident training and asset hybrid or even digital methods for the mental health training.

Census conducted by government of Pakistan in 2017 has shown that more than 10000 trans-genders live in Pakistan. HIV, illicit substance use and mental health issues including depression are the main health problems faced by this part of coummunity

To assess the prevalence of depression among the transgender population and analyze the relationship of socio-demographic factors with depression.

The sample population comprised of one hundred and forty two transgender people of Rawalpindi and Islamabad. Beck depressive inventory II (BDI-II) was used to record the presence and severity of the depressive symptoms. Depressive symptoms were categorized as mild, moderate and severe. Relationship of the age, smoking, family income, illicit substance use and education was studied with the presence of depressive symptoms among these transgender population of twin cities of Pakistan

A total of 142 transgender people were included in the final analysis. Mean age of the study participants was 39.55 ± 6.18. Out of these, 45.1% had no depressive symptoms while 31.7% had mild, 12.7% had moderate and 10.6% had severe depressive symptomatology. After applying the binary logistic regression we found that presence of depressive symptoms had significant association with illicit substance use among the target population.

This study showed a high prevalence of depressive symptoms among transgender population of twin cities of Pakistan. Use of illicit substances like tobacco, cannabis, opiates and alcohol should be discouraged and those using these should be routinely screened for the presence of other mental health issues in order to timely diagnose and treat them

Depression is a common complication of pregnancy and the postpartum period. Up to 70% percent of women report depressive symptoms during their pregnancy, and approximately 10-16% meet full criteria for major depressive disorder. Women with a history of perinatal or non-perinatal major depression are likely to relapse during pregnancy. Research shows that exposure to untreated depression and stress can have negative consequences on the birth outcome and child development. Given the harmful effects of this disease on both the mother and child, it is essential that all pregnant patients be screened for depression. Literature review did not reflect many studies that focus on depression screening in this population, let alone in pregnant patients with Human Immunodeficiency Virus (HIV). Our study focuses on the impact the mandatory screening tool had on the incidence of depression screening in pregnant HIV patients.

- Gain understanding of the Family Focused HIV Health Care Program for Women - Understand the importance of a mandatory screening tool for depression

Using standardized Quality Improvement tools Implementation of screening tool in notes & enforcing a hard stop in the medical records

We noted both qualitative & quantitative improvement in depression screening. Qualitatively the screening has been standardized by creating a universal workflow by the inclusion of screening tools (PHQ2 and PHQ9) in Electronic Medical records. Quantitatively there has been a 34.9% improvement in screening by the case managers in the post interventional quarter.

Significant improvement noted in the incidence of depression screening by implementation a mandatory screening tool

Much has been written about psychosocial treatments (psychoeducation) in schizophrenia. However, for the psychiatric hospital as an organization wishing to create a service guided by an international wave of research there is a need for solutions which are practical and effective in addressing the gender issues and women patients’ needs.

This paper looks at and describes the process employed to develop a guidance document to enable the psychoeducation to provide information and to offer support to its women patients (pre- and post- menopausal age) in dealing with schizophrenia. Essential to this project was the understanding that the guidance would be easy to understand and practical whilst maintaining its strong foundation of research and good practice.

Women patient profile in a schizophrenia group hospitalized at the Moscow-based Psychiatric Hospital was analyzed.

Females of pre- and post- menopausal age actually outnumber males. Such women patients are unique in their needs and demands for health services. This is important subgroup, and some psychosocial interventions should be developed for them. Mental health professionals should be familiar with the unique health problems of these women, and the potential that psychoeducation have to increase their health awareness (information on menopause and aging, oestrogens and depression, on other somatic and psychological influences around menopause, on effects of physical activity etc.).

The implications of this guidance document to enable the psychoeducation for mental health promotion are discussed, in particular the gendered nature of perception of psychosocial treatments in schizophrenia.

There has been an increasing amount of research examining the addictive nature of self-harm (non-suicidal self-injury). One such area of research has examined if themes related to addiction are present in self-harm board postings on imessages. Recent research from the UK suggests that such themes are evident.

The present aim was to build on previous research to examine if themes of addiction are present in other cultural contexts.

A sample of 254 online postings from a self-harm discussion forum on a Russian Internet message board were translated, extracted, read, and re-read before being coded using inductive content analysis to identify themes.

Five themes were extracted and labelled: “Relationships with Family and Friends”, “Self-Blame and Hatred”, “Ongoing Battle”, “Positive affect”, “Other Mental Health Problems Difficulties”. These themes are somewhat similar to those found within messages in a UK based self-harm forum.

The present findings, obtained from Russian respondents, provide further evidence demonstrating that repetitive self-harming seems to have addictive aspects.

Autism is a neurodevelopmental disorder that is considered more common in males; however, ascertainment estimates of ASD in the UK population suggest a significant proportion of female cases of ASD go unrecognised and undiagnosed. This review examines whether the apparent underdiagnosis of girls may be attributed to gender sampling bias in the validation of diagnostic instruments routinely used to diagnose autism.

To compare the gender ratio in validation samples of commonly used diagnostic tools for autism to estimates of the gender distribution of children with autism in the UK population

A review of diagnostic tool manuals and a targeted literature search identified the gender of sample participants used to validate tools used by Scottish ASD services. Analysis of validation samples compared the mean percentage of female participants with ASD to estimates of the proportion of girls with ASD in the UK population.

Data on 7 tools was extracted. The mean percentage of female sample participants with ASD was significantly lower than the ascertainment estimate of females with ASD in the UK population (p=0.010, t(6)=-3.67) and significantly lower than the mean percentage of females in comparison groups (p=0.010, t(12)=-3.06).

There is low representation of females in validity samples of tools, which may reduce their sensitivity to the female phenotype and contribute to diagnostic disparities. Future research is warranted on why instruments are poorer detectors of ASD in girls and how female features of ASD could be better represented in their structure.

Incidence for depression increases during the perinatal period. Risk factors for depression may differentially affect each time period.

To assess demographic, psychological and obstetric risk factors that differentially affect prenatal and postpartum depression

A total of 169 subjects participated. Assessment was conducted during the first trimester, second trimester, third trimester, within a month after childbirth, and a month after childbirth. Demographic and obstetric measures, as well as psychological measures, including the Edinburgh Postnatal Depression Scale were conducted. Multiple regression and the Mann-Whitney U test were performed to examine the association between variables and depression scores.

Depression score was higher during the postpartum period than the prenatal period. Younger age was associated with depression during the first trimester. In the second trimester, less education, a history of depression and having stress within a year significantly affected depression scores. Smoking, artificial abortion and lack of support from family and parents correlated with depression during the third trimester. Within a month after childbirth, psychiatric and depression history, smoking, stress level within a year and lack of family support were associated with depression. At a month after childbirth, those who were primiparous and not breastfeeding had significantly higher depression scores.

This study identifies various risk factors for each gestational and postpartum period and suggests differential interventions for different perinatal periods.

Mental health disorders are considered a priority in health policies around the world. It is estimated that more than 900 million people worldwide have a mental disorder, in which stress-related disorders account for a high number of emergency department visits. The scientific literature has pointed out the importance of considering how gender and sex differences influence the clinical outcomes of people with mental illness, playing an important role in the clinical management of these patients.

The aim of this report is to investigate the presence of gender differences in the care of psychiatric patients attending the emergency department (ED), taking into account the clinical characteristics, reasons for consultation and practices.

The study considered all episodes of patients who visited the ED during 2017 and who were assessed by the psychiatric department. Statistical analyses were performed using IBM SPSS Statistic software.

During the 12 months period, a total of 3180 episodes were evaluated by the psychiatric department in the ED. Of them, 1723 were female (54,2%) and 1457 male. Regarding clinical data, there were found statistically significant differences with respect to the pharmacological prescription in the ED, specifically in the prescription of benzodiazepines, psychiatric diagnoses after discharge and the indication of hospital admission between women and men.

This study emphasizes the importance of considering the existence of gender differences in both the clinical presentation as well as in the care of psychiatric patients attending the ED. The analysis of these variables would help to improve the health care of psychiatric patients.

Domestic violence is a troubling problem, but it has acquired a new, previously unknown significance during the COVID 19 pandemic. According to WHO, the number of calls from victims of domestic violence to hotlines during quarantine in many countries has increased by an average of 5 times.

The purpose of this study was to find out the consequences of domestic violence against women and to identify psychological problems and mental disorders. Attention was paid to the mental health of victims of violence in self - isolation during COVID-19 pandemic.

We analyzed the psychological problems and mental disorders of women who applied to the newly created hotline for women at the Serbsky Center in Moscow during the COVID 19 pandemic.

The situation caused by restrictive quarantine measures related to the COVID-19 pandemic provokes aggressiveness and all forms of domestic violence.Clinical interview has revealed depression, anxiety, fear, low self-esteem, self-harm behavior, which formed the clinical picture of adaptation disorders, acute stress disorders, PTSR, psychosomatic disorders, substance abuse), sexual dysfunctions, eating disorders in the form of bulimia and anorexia.

The study requires taking into account social, economic and gender characteristics. In all types of emergencies, including epidemics, violence against women tends to increase. This is facilitated by a number of factors, such as the crowding of the stay,a decrease in prosperity, provocation of alcohol abuse, state of uncertainty.

A diagnosis of infertility is a stressful emotional experience for women, leading to a significant detrimental impact in many domains of life quality.

The aim of this study is to explore the correlation between perceived infertility-related stress and fertility quality of life in affected women.

The study sample comprised 236 women diagnosed with primary infertility, recruited from the Gynecology Obstetrics Clinic, with a mean age of 33.21 years (min 20, max 46) and with a mean duration of conception attempts of 3.24 years (min 1, max 16), assessed by the Fertility Problem Inventory (FPI) and the Fertility quality of life questionnaire (FertiQol).

The mean FPI and FertiQol were 137.23 (SD=29.066) and 65.356 (SD=11.119) respectively. There was a significant negative correlation between perceived infertility-related stress and fertility quality of life (r= -.513; p<0.01). All the subscales of the applied questionnaires showed significant negative correlations, with exception of Need for parenthood and Rejection of childfree lifestyle subscales of FPI and Treatment related quality of life of FertiQol. Furthermore, the total FPI score could significantly predict the total FertiQol score (F=83.386; df=1:234; p<0.01). On the basis of perceived infertility-related stress, a 26.3% variance of fertility quality of life can be explained.

Women diagnosed with primary infertility who experience higher levels of infertility-related stress had a lower level of fertility quality of life.

Munchausen syndrome by proxy, is a very rare form of abuse, lying on the border between pediatric, psychiatric and legal fields.

To describe a case of Munchausen syndrome by proxy in a mother after the discovery of severe hypoglycemia in her 14-month-old child, hospitalized in the CHU Hédi Chaker Sfax pediatric ward.

This is a presentation of a clinical case and review of the literature via pubmed using the following keywords : “children, abuse, maltreatment, Munchhausen syndrome”.

This is a 23-year-old woman, mother of two daughters, with a psychiatric history, married to a 43-year-old men known to have diabetes on insulin for several years. The patient was admitted to our ward under constraint for aggressiveness towards her one-and-a-half-year-old daughter. Indeed, one month before her hospitalization, her youngest daughter was hospitalized (accompanied by her mother) in the pediatric department at the Hédi Chaker Sfax University Hospital for severe hypoglycemia (0.3g / l). During hospitalization, the girl presented a more severe hypoglycaemia relapses (0.1g / l) and neurological complications. As the mother was indifferent to her daughter’s troubles and was neglectful of her while caring for the other hospitalized children, a mother-child separation was decided and then the blood sugar levels was stabilized. Besides, several other incidents have been happening repeatedly for the two children. In view of the total history, Münchhausen syndrome by proxy has been mentioned.

Munchausen syndrome by proxy is a complex form of child abuse by the mother, representing a major diagnostic and therapeutic challenge for both somaticians and psychiatrists.

Research into sociocultural mediation of mental health engages the factor of gender differences in the subjective assessment of emotional state.

The current study aims to identify the features of the subjective assessment of emotional state in men and women.

The study involved 210 men and 403 women aged 14 to 76 years (M = 26.9; SD = 13.7) from six regions of the Russian Federation: Moscow, St. Petersburg, Udmurtia, Sakha, Sverdlovsk and Kemerovo. Participants were asked to evaluate their emotional state at the present time, choosing one of the following answers: “excellent”, “good”, “average”, “poor”, “very poor”.

The same pattern of the answer frequency distribution was established for men and women. “Good” was the most frequent answer (40% in men and 40% in women), followed by “average” (32% and 36%), “excellent” (18% and 12%), “poor” (9% and 11%), and “very poor” (1% and 2%). Statistical analysis on a rank scale with t-test for independent samples showed that the differences in the subjective assessment of emotional state in men and women are significant (t = 2.132; p = 0.033).

Thus, both men and women rarely choose the extreme answers to assess their emotional state. Despite this similarity, there are statistically significant gender differences in the subjective assessments of emotional state: men are more likely to choose the answer “excellent” and use the answers “average”, “poor” and “very poor” less frequently. The reported study was funded by the RFBR, project number 17-29-02506.

Individuals with Autism Spectrum Disorder without intellectual disabilities (High Functioning ASD, HF-ASD) present atypical sensory sensitivity, due to the hyper-reactivity to sensory inputs.

To retrospectively evaluate the sensory sensitivity in a sample of mothers with HF-ASD during pregnancy (pre-partum), delivery and childbirth (peri-partum) and during the three months after delivery (post-partum).

19 HF-ASD and 13 neurotypical (NT) mothers were asked to complete an ad-hoc questionnaire designed for the study, named Maternity Questionnaire, assessing sensory perception during pre-, peri- and post-partum. Moreover, they underwent the following assessment: the Autism-Spectrum Quotient (AQ), the Empathy Quotient (EQ), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), the Edinburg Postnatal Depression Scale (EPSD), the Sensory Perception Quotient (SPQ) and the Post Partum Bonding Questionnaire (PBQ).

At the Maternity Questionnaire, HF-ASD mothers showed higher sensitivity scores than NT mothers overall. Moreover, HF-ASD mothers presented lower sensitivity during the peri-partum, compared to pre- and post- partum periods, while NT mothers showed a linear decrease from pre- to post- partum. The two groups significantly differed at the AQ, the EQ, the RAADS-R, the SPQ and Factor 3 of the PBQ. Sensitivity during pre- and post-partum positively correlated with EPDS scores.

Mothers with HFA tend to experience pregnancy, childbirth and the post-partum period differently from neurotypical mothers, particularly in terms of hypersensitivity, although during the peri-partum the hypersensitivity decreases. Further studies investigating these aspects might give fundamental hints to provide proper help to HF-ASD mothers during pregnancy and motherhood overall.

A negative attitude towards the body supposed to lead to eating disorders and to increase the level of social anxiety.

The research aim is to study the characteristics of eating behavior and social anxiety in women who have negative attitude towards their body.

The following methods have been used: Multidimensional Body-Self Relations Questionnaire (MBSRQ); Eating Attitudes Test (EAT-26); Brief Fear of Negative Evaluation (BFNE); Iowa–Netherlands Comparison Orientation Measure (INCOM), Social avoidance and distress scale (SADS). The sample consists of 98 women in the age from 18 to 60 years belonged to three age groups: Group 1: N=41, mean age 21.0+3.1; Group 2: N=29, mean age 29,5+4,9; Group 3: N=28, mean age 47,5+12,5.

We have found out a statistically significant correlation between the negative attitude towards the body and the social anxiety. The more a woman dislike her appearance the higher is the level of social anxiety and the higher is the risk of eating disorders. It should be mentioned that all the negative tendencies are more prounouced in the youngest age group.

The research results can be implemented when designing prevention programs. Such programs are extremely important for young women in the age from 18 to 24 years as they have the highest risk of forming an eatind disorder as well as the social anxiety disorder.

Previous research shows that subjective well-being during pandemic (SWB-P) is related to sociodemographic variables (de Pedraza et al., 2020) and coping (Rasskazova et al., 2020). We hypothesized that SWB-P depends on specific types of optimism and coping with pandemic situation, namely defensive optimism (belief the coronavirus problem is exaggerated) and constructive optimism (belief that people’s efforts help prevent infection and spread of the virus) which effects are mediated by the effects of destructive and constructive coping.

This study aimed to assess the effects of situation specific optimism and coping on SWB controlling for gender.

The sample comprised 1403 university students (68% women, M=20.59, SD=3.66). Online survey has been conducted from 10/4/2020 till 25/4/2020. The measures included LOT-R, the scales of defensive and constructive optimism, and the scales of destructive and adaptive coping with pandemic situation (Gordeeva, Sychev, 2020). Well-being was assessed by sum of positive affect minus negative affect (PANAS) and SWLS (Diener et al., 1985).

Structural equation modeling shows that SWB-P is related directly to gender (less well-being in women), dispositional optimism, adaptive coping and destructive coping (negatively). The negative effect of defensive optimism was mediated only by destructive coping (p<0.001), the effects of constructive optimism on well-being was mediated by adaptive and destructive coping (both p<0.01) (χ2 (4)= 8.97; p = 0.06; CFI = 0.996; TLI = 0.978; RMSEA = 0.030; PCLOSE = 0.886).

Dispositional optimism together with situation-specific defensive and constructive types of optimism and coping are essential for explaining well-being during Covid-19 lockdown.

Spousal abuse (SA)against women, by its frequency and its consequences on the health of the victims, is a public health issue. For this reason, the role of the physician is essential not only in the care of victims but also in the study of the determinants of(SA).

To study the profile of women who have experienced(SA), their spouses and to evaluate the factors associated with spousal violence.

Analytical and descriptive cross-sectional study conducted among married patients who consulted the National Health Fund of Sfax(CNSS) during the months of October and November 2019.The sociodemographic and clinical characteristics of the victims and their spouses were collected using a pre-established form.

57.3% of the population was affected by(SA). The mean age of female victims was 48.35 years(SD=9.82). 66.7% of women had a primary school level and 69% had a median socioeconomic level. The majority (60.3%) were housewives.78.18% had a somatic history. The average age of spouses was 53.82(SD=10.87).73% had an elementary school education and 49% were workers.The spouse’s somatic history was found in 63.5% and psychiatric history in 11.11%. 39.68% of spouses had addictive behaviours. Factors correlated with (SA) were: low education levels of the wife (p=0.016) and husband (p=0.0057), history of childhood abuse of the victim (p<0.0001), addictive behaviours of the husband (p=0.008).

It seems that the evaluation of the characteristics of women victims of (SA) and their spouses, as well as the identification of factors associated with (SA), are essential in order to cope with this scourge and avoid its repercussions.

spousal abuse-victims-determinants-profile

Perinatal grief is the reaction to the death of a loved one in the perinatal period (according to the WHO, it ranges from 22 weeks of gestation to the 1st week of postnatal life). Despite the fact that perinatal grief presents a set of distinctive characteristics, it is not recognized as a differentiated entity in the main diagnostic manuals (DSM-5 and ICD-11). There are a number of characteristics that make perinatal grief a different grief reaction. Characteristics that make perinatal grief a different grief reaction:

General characteristics: Proximity between the beginning and the end of life, the lack of religious rituals that legitimize the loss. Physiopathological characteristics; The gestational hormone increase act in the brain favoring emotional bonding with the child and facilitating care, sustained modifications in the gabaergic, endorphinic and nitrinergic synapses in the mothers’ brains. Increased physical activity of the fetus during the third trimester increases the mother’s basal metabolism and changes her emotional reaction. Clinical characteristics; feelings of guilt, loneliness and detachment, irritability, dissociative symptoms, concern dead son and angry reactions.

Search for the specific characteristics of perinatal grief and the importance of its therapeutic approach.

Literature review using pubmed database and scientific dissemination articles.

Between 10 and 50% of mothers who suffer perinatal grief develop depression disorder, 50% have anxiety disorders that usually reappear with the possibility of a new pregnancy, and between 5 and 25% are diagnosed with post-traumatic stress disorder.

Perinatal grief has characteristics that differentiate it from other grief reactions; mental health professionals must attend to and understand these specificities in order to attend it.

Decisions about use and safety of antipsychotic drugs during pregnancy it’s been a controversial issue in psychiatric practice because of the difficult finding the good choice, ethically and medically.

To provide an example of a real case to shed light about the psychopharmacological and ethical management of the situation helping a psychotic patient to make a voluntary decision.

Expose a clinical case of a patient in a psychiatric institution for several psychotic symptoms who we discover she’s pregnant during her hospitalization and treatment process. She is a 36 years old single woman who shows disorganized maniac psychotic behavior including disinhibition, promiscuity, persecutory and symbolic delusional ideas, self-surrender and insomnia. She’s admitted against her will in a University Hospital, being transferred to a Psychiatric Hospital with risperidone (2mg/24h) and clonazepam 2mg (2mg/24h). She had a positive pregnant test. Receiving the patient, we made an updated bibliographical review about use of antipsychotic during pregnancy, consult with the patient’s family and hospital legal advice’s service and coordinate with Gynecology’s service. The patient was ambivalent about the decision conditioned by her symptoms.

We decide to optimize drugs to olanzapine (until 30mg/24h) during the first week not using mood stabilizers because of malformations risk, with a great amelioration of symptoms, experiencing a back to reality with a coherent speech and eutimia, deciding a voluntary interruption of pregnancy.

Psychosis in pregnancy can be a bioethical challenge wich must be management according to science (practice clinical guidelines point olanzapine as a choice to be considered) and woman’s will.

Women from ethnic minorities who experience mental health problems during the perinatal period are disproportionately represented in involuntary care. They have poorer access to community care but have higher engagement with services once accessed. Their pathways to accessing perinatal mental health care remain underexplored.

To investigate the pathways to perinatal mental health services for women across different ethnic groups, including number of caregivers encountered and time elapsed between referrals.

Analysis of patient records and routine service data from community and inpatient perinatal mental health services in the United Kingdom. Use of an adaptation of the WHO’s pathway encounter form.

Women from ethnic minority groups experience increased levels of complexity on their journey to accessing perinatal mental health care. We will present a detailed analysis of patient and service characteristics.

Referral pathways to perinatal mental health services need to be optimised for women from underrepresented groups.

Female sexual dysfunction (FSD) can be overlooked. Different types of breast cancer surgery could have a different impact on the sexuality of women. Artificial intelligence (AI) could help to determine the relation between those conditions.

To investigate whether AI could predict FSD relying primarily on the time elapsed after treatment and the type of breast cancer surgery.

Data of age, time elapsed after treatment and type of surgery (breast-conserving therapy and mastectomy) were employed to predict FSD status in 128 subjects using an AI. Women with and without steady relations were included in the analysis. FSD prevalence was 27.3%. The AI was conservatively tuned to maximize the positive likelihood ratio considering predicted and real FSD statuses. The free and open source programming language R was used for all the analyses. Dataset source: Nowosielski, Krzysztof; Krzystanek, Marek; Kowalczyk, Robert; Streb, Joanna; Kucharz, Jakub; Głogowska, Iwona; Lew-Starowicz, Zbigniew; Cedrych, Ida (2018), “Data for: Factors affecting sexual function and body image of early stage breast cancer survivors in Poland: A short-term observation.”, Mendeley Data, V1, doi: 10.17632/948n98trm6.1

Predictions obtained a positive likelihood ratio of 5.314. The results were indicative of fair performance.

AI might be useful to predict FSD in women who undergo breast cancer surgery. Furthermore, the results of this study might indicate a moderate effect of age, time after treatment and type of surgery on the probability of FSD occurrence. Finally, the AI used in this study is freely available, allowing anyone to experiment.